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New Mexico Health System Innovation Design Phase

New Mexico Health System Innovation Design Phase. Improving health outcomes and population health “ For A Healthier New Mexico ” STATE INNOVATION MODEL (SIM) INITIATIVE FUNDED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, CMS INNOVATION CENTER.

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New Mexico Health System Innovation Design Phase

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  1. New Mexico Health System InnovationDesign Phase Improving health outcomes and population health “For A Healthier New Mexico” STATE INNOVATION MODEL (SIM) INITIATIVE FUNDED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, CMS INNOVATION CENTER

  2. What is the State Innovation Model [SIM] Initiative? • Created by the Affordable Care Act (ACA); administered by the Centers for Medicare and Medicaid Services (CMS) Innovation Center • To test innovative health delivery & payment models that reduce spending, enhance the quality of care & improve population health • Since 2012, more than $1 billion awarded to 34 States, 3 territories and the District of Columbia • Two phases: Design (1-2 years to develop the design of proposed transformation model); Testing of design (3 years)

  3. New Mexico Health System Innovation The Design • Based on “The Triple Aim” • Enhancing the consumer’s experience of care • Reducing health care costs • Improving population health and health outcomes.

  4. Examples of Triple Aim Goals Enhanced experience of care Improved primary care with patient-centered medical homes (PCMH) model - integration of primary care, behavioral health services and social services Reduction of costs Reimbursement of services is value (outcome)-based vs. fee-for-service (volume) May include reimbursement for “non-traditional” services, i.e., those provided by community health workers, social services, etc. Improving population health & health outcomes Local community health workers& paramedics who participate in the delivery of primary care Interoperability of health information systems

  5. What does “health system transformation” look like?

  6. What are the Objectives of NM’s Design? • Alignment and integration of public health, behavioral health and primary care • Reducing costs & slowing the rate of health care inflation • Increasing the number of New Mexicans who have health insurance • Building the healthcare workforce & supporting infrastructure • Expanding the use & integration of health information technology (HIT)

  7. Who will participate? Extensive stakeholder engagement • State agencies • Local & tribal governments • Health care providers • Public payers (Managed Care Organizations (MCOs) and private commercial payers • Social service providers • Patient advocacy groups • Local organizations • Business community • Local Community, in collaboration with HCs

  8. Suggestions for Community Representatives Behavioral health (individual providers/clinics, etc.) Business community/chamber of commerce Health consumers/general public EMS/paramedicine/emergency management Environmental/community planning organizations Food bank Health professional organization Higher education health clinic Hospital Insurer (public & private) Local government Patient advocacy/consumer Primary care (individual providers/FQHC/local private clinic, etc.) School-based health clinic Tribal health services Vulnerable population advocacy organization

  9. Police HomeHealth EMS Corrections MCO’s Health Department Churches Community Centers Philanthropist NursingHomes Doctors Parks Schools Elected Officials Hospitals MassTransit Environmental Health Civic Groups CHCs Fire Employers TribalHealth Laboratory Facilities Economic Development Drug Treatment Mental Health Stakeholdersin the Public Health System

  10. Engagement Structure Six Stakeholder Committeesand Local Communities - • Population Health - to address health issues across the life continuum • Health Care • Health Care Workforce • Payers • Tribal • Health Information System (Health Information Technology; Health Information Exchange; Healthcare System Information; Health Status; Individual Health Info); and, • Ongoing Community Engagement (County & Tribal Health Councils)

  11. Governor’s Office Health System Innovation Committee (HSIC) Flow of Design Inputs Input Compiled for Model Design SIM Management Team (OPA/HSD Admin. Staff) Community Engagement led by Health Councils (HCs) Stakeholder Committees Work Groups

  12. Innovation: Priority Health Issues • Obesity Prevention and Control • Diabetes Prevention and Control • Tobacco Use Prevention and Control

  13. Important Considerations Social Determinants of Health

  14. Important Considerations for HCs Diffusion of Innovation seeks to explain how innovations are taken up in a population. An innovation is an idea, behavior, or object that is perceived as new by its audience. Diffusion of Innovations offers three valuable insights into the process of social change: • What qualities make an innovation spread. • The importance of peer-peer conversations and peer networks. • Understanding the needs of different user segments.

  15. Timeline • May 19: Stakeholder Summit (kick-off), Albuquerque • May-July: Community orientations & development of engagement plans for three succeeding community engagement sessions • July – October 5: With DOH Health Promotion Teams, conduct community engagement sessions to provide input to Design • October 15: Draft Community Stakeholder Design recommendations by theme provided by NM Alliance of Health Councils

  16. Timeline • Week of October 19: All Stakeholder Committees to meet in Albuquerque • Week of November 2: Health System Innovation Committee (HSIC) reviews proposed design from Stakeholder Committees & local communities • Week of November 16: Stakeholder Committees convene in Albuquerque • December 1: Final design sent to HSIC • December 15: Final Community Stakeholder Design recommendations by Theme due from NM Alliance of Health Councils • December 15: Stakeholder Summit to occur in Albuquerque to present final design

  17. Community Engagement Planning • Health Councils review existing membership & identify additional representation for community input sessions • DOH Health Promotion Teams collaborate with Health Councils & NM Alliance to gather recommendations for Health System Innovation Design • Statewide standardized approach that includes flexibility to accommodate local needs

  18. Community Engagement Planning • Overall Goal: To provide recommendation on proposed innovation design • Question to consider: “Does the proposed design achieve the Triple Aim in your community?” • NM Alliance of Health Councils & DOH Health Promotion Teams collaborate to assist HCs with input session format, materials, process, and agenda • Succeeding sessions to provide recommendation to the design

  19. Get Ready • Identify three dates & locations for the community engagement sessions during July 1 - October 5, 2015 • Review existing Health Council membership to ensure widest possible input • Identify list of invitees (Individuals &Organizations) & begin to distribute “save the date” notices • Materials, templates, and more information will be available in June

  20. Preliminary Community Engagement Plan Outline GOALS: • Ensure maximum input and engagement in the Health System Innovation planning process by New Mexico counties and tribal communities • Develop community health planning processes that will benefit communities, resulting in increased understanding of: • Community assets • Community health needs, gaps, issues • Locally identified health priorities • Stakeholder involvement strategies • Prepare communities for possible participation in a SIM Implementation Phase

  21. Stages of Community Engagement 1. Orientation to the NM Health System Innovation planning process: • Power Point presentation to health councils and community groups • Discussions of strategies for involvement of all sectors and stakeholders • Preliminary discussions of the kinds of input being sought

  22. Stages of Community Engagement 2. Development of methods for community/stakeholder engagement: • Identification of sectors currently represented on health councils • Identification of sectors & stakeholders who should be at the table • Methods for reaching & engaging community stakeholders: • Expanded health council meetings • Regional, multi-council meetings • Focus groups • Other community coalitions, networks • Community surveys • Other potential groups: e.g., community coalitions, volunteer groups, schools, business groups, faith communities, advocacy groups

  23. Stages of Community Engagement 3. Community Input: Identify information to be gathered prior to development of design 4. Community Input: Responses to proposed design

  24. Community Input Information Framework Research Questions: • How can the Triple Aims be achieved in your community? • How do each of the factors below help or hinder achieving the Triple Aim?

  25. Aims & Objectives 1. Improve Population Health: • Integration of population health, prevention, & primary care • Address social determinants of health • Create environments that offer health choices

  26. Aims & Objectives 2. Enhance Patient Experience of Care: • Patient-centered care • Integration of primary care, behavioral health, & oral health • Chronic disease management • Access, health care workforce development

  27. Aims & Objectives 3. Reduce Health Care Costs: • Reform payment systems • Increase health insurance coverage • Expand health information technology

  28. Factors that Help/Hinder Achieving the Triple Aim • Environmental (Geographic, social & cultural factors) • Current Strengths, Resources • Community Needs/Gaps/Barriers • Health Priority Areas • Potential Solutions

  29. The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.  The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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